| NPI | 1235721085 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA JEAN KIDBY Provider/Owner 541-295-5172 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2021-02-03 |
| Last Update Date | 2024-07-09 |